Healthcare Provider Details

I. General information

NPI: 1043607294
Provider Name (Legal Business Name): CTUC03 P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MILL PLAIN RD
DANBURY CT
06811-5178
US

IV. Provider business mailing address

100 MILL PLAIN RD
DANBURY CT
06811-5178
US

V. Phone/Fax

Practice location:
  • Phone: 203-826-2600
  • Fax: 203-826-2139
Mailing address:
  • Phone: 203-826-2600
  • Fax: 203-826-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateCT

VIII. Authorized Official

Name: THOMAS KELLY
Title or Position: DIRECTOR
Credential:
Phone: 860-484-9193